Columns, Training

A Guide to Integrating Simulation into EMS Education

Issue 2 and Volume 42.

In 2015, the Simulation Use in Paramedic Education Research (SUPER) study was published, confirming what many of us in EMS education already knew: Simulation is an important part of EMS education.1

Simulation is defined as a teaching modality that “creates a situation or environment to allow persons to experience a representation of a real event for the purpose of practice, learning, evaluation, testing or to gain understanding of systems or human actions.”2

There’s a long tradition of using simulation in EMS education, from task trainers and manikins to standardized patient role players.

This new bi-monthly column goes beyond the task trainer or manikin and is dedicated to expanding the purposeful use and understanding about evidence-based EMS simulation practice. Our goal is to help our colleagues overcome barriers to using simulation and expand effective simulation practice by exploring best practices for using this important teaching methodology and modality.

A Daunting Challenge

Integrating simulation is often considered a painstaking process that may utilize more time and resources than typically available. EMS educators are challenged to meet the needs of the organization and their learners without compromising the integrity of the learning experience.

Many educators have observed EMS simulation competitions at conferences and mistakenly walk away believing that the design of a simulation EMS activity has to challenge the participants to the maximum level. This couldn’t be farther from the truth. In fact, this could actually negatively affect learning.

Integrating simulation may sound daunting, but the foundational groundwork has already been paved for expanding the use of simulation. As an educator, you likely already use key principles of simulation, so the true question rests not on how to implement, but how to expand the use of simulation while at the same time meeting the needs of the organization and students.

Ultimate success involves understanding the organization’s needs (e.g., what EMS agency leaders want to teach) and the participant’s needs (e.g., demonstrating the skills required by EMS agency leadership) and then leveraging simulation to help improve the transfer, retention and application of knowledge.

This is more relevant than ever before, now that the National Registry of EMTs incorporates simulation scenarios as part of the paramedic examination process.

Activity Development

All effective simulation activities begin with a needs assessment meant to identify the intended participants, the knowledge of the participant and the skills that will be assessed. This needs assessment helps educators to develop measurable learning objectives.

Consider the different educational needs for someone just entering EMS vs. someone who’s been in the industry for decades and the value of a needs assessment before designing education activities becomes clear.

It’s important to keep measurable objectives in mind, as the design of the simulation activity is critical to its success. Effective simulation is designed using sound methods and principles with the goal that students gain competence in or observe and assess the outlined learning objectives within a safe, learning-conducive environment.

Simulation design doesn’t have to be complex, and one way to make the challenge less daunting is to design your activity around one of the four basic frameworks of simulation activities:3

1. Teaching and education: Activities in this framework are focused on acquiring new skills (e.g., delivering intranasal naloxone, obtaining IV access, assessing a patient’s airway); learning new equipment; gaining interpersonal skills (e.g., communication during crisis, team-leading abilities); understanding complex situations (e.g., disaster management, rare but high-acuity cases); and preparing for clinical contact with patients.4

2. Assessment and evaluation: Activities developed in this framework are designed to assess existing knowledge and evaluate skill mastery. Examples include: Conducting baseline assessment of students at any level or prior to any activity (e.g. new EMT students, seasoned paramedics taking a critical care course); determining the completion of coursework or semester knowledge; screening new hires; and ensuring adherence to protocols and processes under distraction or uncontrolled environmental pressure.

3. System integration and improvement: Activities in this framework are designed to build or improve the operational functioning of an EMS system or agency. Examples include: enhancing team and crisis communication; improving medication administration practices; evaluating system analysis and root problem identification; re-creation of actual patient care events for all members to experience; and testing of systems (e.g., new policy implementation, disaster preparation, incident management systems, rescue task force).

4. Research: A more advanced use of simulation, research activities must be properly designed and adhere to the rigorous research standards that advance both the reliable assessment of the activities as well as investigation of the results.

By using best practices, simple process tools and scenarios built around these four frameworks, you can easily turn a dry, run-of-the-mill scenario into a rich educational experience.

After completing the needs assessment and simulation design, it’s important to pilot test the scenario or activity to ensure the design meets your objectives.

A debriefing after the activity allows for participant reflective learning, where decisions made during the simulation are discussed so participants can discover the “why” of their actions and choices. Debriefings aren’t meant to be a mini-lecture or expanded teaching activity, and the environment must be safe and nonjudgmental to be conducive to learning.


Using effective and well-thought out simulation activities can offer so much more to the EMS community than haphazard scenarios or case studies. It’s important EMS educators take the time to be creative and take into consideration how simulation can be used as a tool to help drive forward the standards of patient care and improve system processes.

Throwing a manikin on the ground and simply reproducing a good call isn’t quality simulation, but when integrated with learning objectives and correct placement in the curriculum, expanded with evidence, and trialed before execution, that good call can be the foundation of a great simulation activity.


1. McKenna KD, Carhart E, Bercher D, et al. Simulation Use in Paramedic Education Research (SUPER): A descriptive study. Prehosp Emerg Care. 2015;19(3):432–440.

2. Lopreiato JO (Ed). (2016.) Healthcare simulation dictionary. Agency for Healthcare Research and Quality. Retrieved Dec. 20, 2016, from

3. Deutsch E, Palaganas J: SSH accreditation standards. In Palaganas J, Maxworthy J, Epps C, et al (Eds.), Defining excellence in simulation programs. Lippincott Williams & Wilkins: Baltimore, 2015.

4. Mills BW, Carter OB, Rudd CJ, et al. Clinical placement before or after simulated learning environments? A naturalistic study of clinical skills acquisition among early-stage paramedicine students. Simulation in Healthcare. 2015;10(5): 263–269.